Identification of Serum Biomarkers in Patients with Alzheimer’s Disease by 2D-DIGE Proteomics

<b><i>Aim:</i></b> The aim of this study is to identify potential serum biomarkers of Alzheimer’s disease (AD) for early diagnosis and to evaluate these markers on a large cohort. <b><i>Methods:</i></b> We performed two-dimensional difference gel electrophoresis to compare the serum of AD patients and normal controls. Western blot or enzyme-linked immunosorbent assay (ELISA) was used to identify the expression levels of proteins. <b><i>Results:</i></b> In this study, a total of 13 differentially expressed proteins were identified. Among them, 2 proteins (inter-alpha-trypsin inhibitor heavy chain H4 [ITI-H4], Apolipoprotein A-IV) were validated by Western blot and 4 proteins (Cofilin 2, Tetranectin, Zinc-alpha-2-glycoprotein [AZGP1], Alpha-1-microglobulin/bikunin precursor [AMBP]) were validated by ELISA, respectively. Western blot results showed that the full size of the ITI-H4 protein was increased, while a fragment of ITI-H4 was decreased in AD patients. In contrast, 1 fragment of Apo A-IV was mainly found in control group and rare to be detected in AD patients. On the other hand, ELISA results showed that Cofilin 2, Tetranectin, AZGP1, and AMBP were significantly increased in AD patients, and Cofilin 2 is strongly correlated with the Mini-Mental State Examination scores of the AD patients. Serum Cofilin 2 was unchanged in Parkinson disease patients as compared to the control group, indicating a specific correlation of serum Cofilin 2 with AD. Moreover, Cofilin 2 was increased in both the serum and brain tissue in the APP/PS1 transgenic mice. <b><i>Conclusion:</i></b> Our study identified several potential serum biomarkers of AD, including: ITI-H4, ApoA-IV, Cofilin 2, Tetranectin, AZGP1, and AMBP. Cofilin 2 was upregulated in different AD animal models and might play important roles in AD pathology.

Characteristics and Outcome Determinants of Hospitalized Older Patients with Cognitive Dysfunction

Cognitive dysfunction commonly occurs among older patients during admission and is associated with adverse prognosis. This study evaluated clinical characteristics and outcome determinants in hospitalized older patients with cognitive disorders. The main outcomes were length of stay, readmission within 30 days, Barthel index (BI) score at discharge, BI score change (discharge BI score minus BI score), and proportion of positive BI score change to indicate change of activities of daily living (ADL) change during hospitalization. A total of 642 inpatients with a mean age of 79.47 years (76–103 years) were categorized into three groups according to the medical history of dementia, and Mini-Mental State Examination (MMSE) scores at admission. Among them, 74 had dementia diagnosis (DD), 310 had cognitive impairment (CI), and 258 had normal MMSE scores. Patients with DD and CI generally had a higher risk of many geriatric syndromes, such as multimorbidities, polypharmacy, delirium, incontinence, visual and auditory impairment, fall history, physical frailty. They had less BI score, BI score change, and proportion of positive BI score change ADL at discharge. (DD 70.0%, CI 79.0%), suggesting less ADL change during hospitalization compared with those with normal MMSE scores (92.9%; p < 0.001). Using multiple regression analysis, we found that among patients with DD and CI, age (p = 0.008) and walking speed (p = 0.023) were predictors of discharge BI score. In addition, age (p = 0.047) and education level were associated with dichotomized BI score change (positive vs. non-positive) during hospitalization. Furthermore, the number and severity of comorbidities predicted LOS (p < 0.001) and readmission (p = 0.001) in patients with cognitive disorders. It is suggested that appropriate strategies are required to improve clinical outcomes in these patients.

Random Forest Model in the Diagnosis of Dementia Patients with Normal Mini-Mental State Examination Scores

Background: Mini-Mental State Examination (MMSE) is the most widely used tool in cognitive screening. Some individuals with normal MMSE scores have extensive cognitive impairment. Systematic neuropsychological assessment should be performed in these patients. This study aimed to optimize the systematic neuropsychological test battery (NTB) by machine learning and develop new classification models for distinguishing mild cognitive impairment (MCI) and dementia among individuals with MMSE ≥ 26. Methods: 375 participants with MMSE ≥ 26 were assigned a diagnosis of cognitively unimpaired (CU) (n = 67), MCI (n = 174), or dementia (n = 134). We compared the performance of five machine learning algorithms, including logistic regression, decision tree, SVM, XGBoost, and random forest (RF), in identifying MCI and dementia. Results: RF performed best in identifying MCI and dementia. Six neuropsychological subtests with high-importance features were selected to form a simplified NTB, and the test time was cut in half. The AUC of the RF model was 0.89 for distinguishing MCI from CU, and 0.84 for distinguishing dementia from nondementia. Conclusions: This simplified cognitive assessment model can be useful for the diagnosis of MCI and dementia in patients with normal MMSE. It not only optimizes the content of cognitive evaluation, but also improves diagnosis and reduces missed diagnosis.

Evaluation of the health level of the elderly: patient care team considerations

ABSTRACT Objective: To understand the differences of physicians, nurses, and social workers in the evaluation of the health status of the elderly. Methods: A cross-sectional quantitative study, using descriptive statistics. Non-probabilistic sample, consisting of 291 participants from three professional categories: 71 (24.4%) physicians, 192 (66%) nurses, and 28 (9.6%) social workers. We used a questionnaire including the variables: sociodemographic characteristics and instruments used for evaluation. Results: Instruments with greater utility for the evaluation of the elderly: for physicians, Mini Mental State Examination; for nurses, Braden scale; and for social workers, genogram. In the physical examination, the data most collected by physicians and nurses are the vital signs; and by social workers, the condition for performing the Activities of Daily Living. Conclusions: The evaluation of the elderly is based on a diversity of instruments and is an area in which health and social professionals need to share information.

The Effect of Psychological Factors on Cognitive Functions in Stroke Patients With Chronic Fatigue

Background and Objectives: Cognitive and psychological impairments are among the disabling consequences of chronic stroke. Despite the high prevalence of these impairments in patients with chronic stroke and the significant impact of psychological factors on cognitive factors in other neurological diseases, no study was found to investigate the relationship between psychological factors and cognitive factors in chronic stroke patients with chronic fatigue. Therefore, this study aimed to investigate the relationship between psychological factors and cognitive functions in chronic stroke patients with chronic fatigue Methods: A total of 85 chronic stroke patients with chronic fatigue visited the Rehabilitation Centers of Tehran, Iran, were selected through the simple non-probability sampling method and enrolled in this correlational study. The Fatigue Severity Scale, Beck Depression Inventory, and Beck Anxiety Inventory were used to measure the levels of the fatigue, depression, and anxiety of patients with strokes, respectively. Besides, the cognitive functions of the participants were assessed using the Mini-Mental State Examination, the Montreal Cognitive Assessment, and the Pain Visual Analog Scale. Results: Based on the regression models, the Mini-Mental State Examination and the Montreal Cognitive Assessment explained up to 24.2% and 39.6% of the variance of cognitive functions, respectively. In all step-by-step models, the variables of anxiety, education level, and depression were the strongest predictors of cognitive functions. Conclusion: According to the clinical findings, psychological impairments, such as anxiety can adversely affect cognitive factors in chronic stroke patients with chronic fatigue. Therefore, therapeutic interventions focused on psychological factors may considerably improve the cognitive skills of these patients.

HUBUNGAN AKTIVITAS FISIK TERHADAP KUALITAS TIDUR DAN FUNGSI KOGNITIF PADA KELOMPOK LANSIA DHARMA SENTANA, BATUBULAN

Peningkatan jumlah populasi lansia menyebabkan semakin banyak masalah kesehatan yang akan dialami oleh lansia yang disebabkan karena kurangnya aktivitas fisik seperti gangguan kualitas tidur dan penurunan fungsi kognitif. Seiring dengan pertambahan usia dan berkurangnya aktivitas fisik, semakin besar kemungkinan seseorang mengalami gangguan kualitas tidur dan penurunan fungsi kognitif. Aktivitas fisik yang rutin dilakukan oleh lansia dapat mencegah terjadinya gangguan kualitas tidur dan mencegah penurunan fungsi kognitif. Semakin meningkat aktivitas fisik maka semakin meningkat kualitas tidur dan fungsi kognitif pada lansia. Tujuan dari penelitian ini adalah untuk mengetahui hubungan antara aktivitas fisik terhadap kualitas tidur dan fungsi kognitif pada kelompok lansia Dharma Sentana, Batubulan. Penelitian ini adalah cross sectional study dengan teknik pengambilan sampel purposive sampling. Penelitian dilakukan di kelompok lansia Dharma Sentana, Batubulan. Sampel penelitian ini berjumlah 50 orang lansia. Aktivitas fisik diukur dengan International Physical Activity Scale (IPAQ), kualitas tidur diukur dengan Pittsburgh Sleep Quality Index (PSQI), dan fungsi kognitif diukur dengan Mini-Mental State Examination (MMSE). Berdasarkan hasil uji chi-square didapatkan nilai p=0,007 yang artinya ada hubungan antara aktivitas fisik dengan kualitas tidur dan nilai p=0,000 yang artinya ada hubungan antara aktivitas fisik dengan fungsi kognitif. Simpulan penelitian ini adalah ada hubungan antara aktivitas fisik terhadap kualitas tidur dan fungsi kognitif pada kelompok lansia Dharma Sentana, Batubulan. Kata kunci: Lansia, Aktivitas Fisik, Kualitas Tidur, Fungsi Kognitif

Terapia de espelho na reabilitação do membro superior pós Acidente Vascular Cerebral

Introdução: A perda da função motora dos membros superiores é um dos défices mais debilitantes após Acidente Vascular Cerebral (AVC). A Terapia de Espelho (TE) é uma abordagem promissora que visa melhorar a aprendizagem motora e promover a reorganização neural por meio de diferentes entradas aferentes e padrões de feedback visual. Objetivo: Identificar os ganhos obtidos pela intervenção do enfermeiro de reabilitação através de um protocolo de TE. Método. Trata-se de um estudo de caso, com um desenho experimental de caso único, onde foi selecio­nado um indivíduo do sexo masculino, 78 anos, hemiparesia à esquerda, devido a AVC isquémico, com boa capacidade cognitiva. Protocolo de intervenção de 15 sessões, com duração de 30 minutos, onde foi implementada a TE. Os ins­trumentos utilizados foram: Questionário Mini Mental State Examination (MMSE); Escala Motor Activity Log (MAL); Disabilities of the Arrm, Shouder and Hand (DASH) e a Escala de movimento da mão (MM). Resul­tados. Foi observada uma melhoria através do ganho da independência e habilidade motora no membro superior parético pós AVC, após intervenção com TE. Discussão: O paciente avaliado evidenciou melhoria motora durante as atividades de vida diárias (AVD). Este resultado é corroborado por outros estudos de aplicação da TE e o uso da imagética motora, após AVC. Conclusão. A TE gerou efeitos positivos na função motora, do paciente avaliado.

Comparison of the Mini-Mental State Examination and Computerized Brief Cognitive Screening Test as Cognitive Screening Tools in Patients with Mild Cognitive Impairment

Background: The aim of this study was to establish the validity and reliability of the Computerized Brief Cognitive Screening Test (CBCog) for early detection of cognitive impairment. Method: One hundred and sixty participants, including community-dwelling and out-patient volunteers (both men and women) aged ≥ 65 years, were enrolled in the study. All participants were screened using the CBCog and Mini-Mental State Examination (MMSE). The internal consistency of the CBCog was analyzed using Cronbach’s α test. Areas under the curves (AUCs) of receiver operating characteristic analyses were used to test the predictive accuracy of the CBCog in detecting mild cognitive impairment (MCI) in order to set an appropriate cutoff point. Results: The CBCog scores were positively correlated with the MMSE scores of patients with MCI-related dementia (r = 0.678, P < .001). The internal consistency of the CBCog (Cronbach’s α) was 0.706. It was found that the CBCog with a cutoff point of 19/20 had a sensitivity of 97.5% and a specificity of 53.7% for the diagnosis of MCI with education level ≥ 6 years. The AUC of the CBCog for discriminating the normal control elderly from patients with MCI (AUC = 0.827, P < 0.001) was larger than that of the MMSE for discriminating the normal control elderly from patients with MCI (AUC= 0.819, P < .001). Conclusion: The CBCog demonstrated to have sufficient validity and reliability to evaluate mild cognitive impairment, especially in highly educated elderly people.

Role of cholesterol in cognitive function in the elderly

The role of cholesterol in Cognitive Decline is less known as compared to other pathologies linked with dyslipidaemia. However, Cholesterol is well-known to have multiple functions in normal functioning of the brain and the aging process. This study therefore aimed at finding a co-relation, if any, between Cholesterol and age-related cognitive decline.To assess Cognitive Function of subjects and compare it with respective blood cholesterol levels. The study included 50 elderly subjects from Maharashtra (females: 12%) assessed using Marathi version of Mini Mental State Examination (MMSE) and their cholesterol blood concentrations obtained using a Lipid Profile investigation. Cholesterol levels and cognitive function was then co-related using statistical analysis.The subjects with a higher Total Cholesterol & LDL Cholesterol had slightly less scores on the Mini Mental State Examination (MMSE) Test. However, the difference was found to be significant.Based on the results obtained, no relevant co-relation could be found between Blood Cholesterol Levels and Cognitive Function